Background/introduction Acute syphilis is on the increase and prompt treatment is vitally important to prevent onward transmission.

Aim(s)/objectives To ensure compliance with BASHH audit outcomes for the management of acute syphilis.

Methods We collected all patients who had been coded as primary or secondary syphilis (A1 or A2) for 12 months from May 2014. Demographics, symptoms at presentation and subsequent management were collected.

Results 132 records were returned with 89% (117/131) identifying as men who have sex with men (MSM). 55% (72/132) were HIV positive, with 3 new HIV diagnoses. 70% (89/128) had symptoms of acute syphilis; with an ulcer, 87% (41/47) had herpes simplex virus (HSV) PCR which was positive in 7% of cases. Dark ground microscopy was performed in 38% (20/52) with one third being positive. 42% (56/131) were treated for syphilis on their initial visit (14% if seen by a technician, 31% if seen by a nurse and 51% if seen by a medic, p = 0.006). 90% had been treated by 2 weeks.

Discussion/conclusion MSM comprised the majority of acute syphilis with high rates of new HIV diagnoses, reinforcing the importance of routine HIV testing. There was a high co-infection prevalence of HSV. Dark ground microscopy was positive in a third of samples, perhaps due to technical difficulties in the clinic. Only 4 in 10 patients were treated at the first visit indicating a lack of awareness of symptoms of acute syphilis. More education on recognising and treating acute syphilis, especially in high risk groups, is needed.